Overeating

Overeating and compulsive eating: therapy in London

For many people who struggle with overeating, the difficulty is not lack of nutritional knowledge or absence of motivation. It is that eating is serving a function beyond nutrition: managing anxiety, filling an emptiness, providing comfort in the absence of other available comfort, or regulating a state that would otherwise be intolerable. Knowing this intellectually rarely changes it, because the pattern does not operate through conscious decision.

Compulsive overeating (eating past fullness, eating without hunger, eating in response to emotional states rather than physical appetite) is a form of emotional regulation that was learned at some point because it worked. The problem is that it works short-term and at long-term cost, both physically and in terms of the relationship with the body and with food itself.

What the therapy addresses

Therapy for overeating works with the underlying emotional regulation, what states the eating is managing, what would need to be different for those states to be tolerable without food, and what in the person’s history created the original need for that particular regulation strategy. This is different from dietary intervention, which addresses the surface of the behaviour without the psychology underneath it.

Hypnotherapy for weight and appetite management is available alongside psychotherapy and can be particularly effective for overeating patterns that are habitual rather than driven by complex psychological material. The initial consultation will clarify which approach (or which combination) is most appropriate.

Everything to do with food, and nothing to do with food

An eating disorder is a complex psychological disorder focused around food. I will say it again, because it matters: a complex psychological disorder focused around food. Everything to do with food, and nothing to do with food. The diets, the weight, the calories, that is only the tip of the iceberg. The real difficulty is beneath the surface: a problem of the self, an emotional, relational, sometimes psychiatric difficulty. That is what has to be treated. A diet, like a weight-loss drug, works only on the tip of the iceberg, never on what is holding it up.

Anxiety, and why chewing soothes

Almost every human being carries some anxiety, that diffuse fear that something, somewhere in the future, is going to go wrong. Putting food in the mouth and chewing pulls a person sharply into the present, and in that instant they are no longer in the feared future: the anxiety lifts for a moment. Then they swallow, the guilt arrives, the future-dread returns, and they have to eat again. That is the loop. It is not greed, it is a person using the only anchor to the present they have found.

Ozempic and overeating

These drugs reduce hunger, but overeating is not about hunger: people eat long after they are full, to numb an emotion. So the drug misses the mechanism, and the urge often resurfaces elsewhere. I discuss this in detail in Ozempic and eating disorders.

The order of the work: emotion first, food second

When the emotional work is carried through, the bingeing stops: food no longer has a job to do. Practical work on diet sometimes remains, because some people, after long work, no longer binge yet stay overweight because they still reach for the wrong food at every meal. But you cannot start there: you treat the emotional root first, and only then does the dietary work become possible and useful. Emotion first, food second.

Overeating and binge eating in men are routinely missed; for the male picture, see Men Who Heal, Dr Jacquet’s men’s eating-disorder practice.